Presentation – Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.

7/28/2019 Presentation Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.

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Deployment Healthcare

A holistic, efficient, and patient-centered

approach to the care of combat veterans

that proactively assesses for the common

and distinct issues of this population and

its subgroups.


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Integrated Deployment Healthcare

Physical

Concerns:

Primary CareProvider

Psycho-socialConcerns:

Social Worker

Psychological

Concerns:

Mental HealthProvider

Veteran


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The War Related Illness and Injury

Study Center (WRIISC)A national program in the Department of VeteransAffairs (VA), initially established in 2001 to address

deployment health issues from the First Gulf War.


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ABOUT THE WRIISC

The WRIISC helps:

Deployed Veterans

Any era or conflict

Unexplained or unusual healthconcerns

Through:

Clinical assessment

Education Research

Risk Communication
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WRIISC Synergies

Clinical Care

Observations from clinical care

lead to research questions and

testable hypotheses, highlight

gaps in provider and patient

knowledge.

Education

Education of patients and

providers can improve patient

outcomes and identify gaps in

knowledge to be addressed

by research.

Research

Research produces

knowledge and evidence-

supported interventions and

tools that can improve patient

care and can be packaged

and disseminated througheducation activities.


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WRIISC REGIONAL MAP


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CLINICAL EVALUATIONS

Comprehensive Interdisciplinary Evaluation Focus is on symptom management and improving function

Three day evaluation as pre-determined by WRIISC clinical team

Environmental Exposure Consults Comprehensive available for Veterans of any conflict

Attempts to link exposures to current health conditions

Educates patient about his/her exposure concerns

eConsults

Medical record review with individualized recommendations for next

steps prior to other WRIISC evaluations


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Comprehensive Evaluation Patients

Complex, deployment-related health

concerns

Difficult to diagnosis, unexplained, or unusual

Concerns about deployment-related

exposures

Environmental & Occupational

Local work up inconclusive or unavailable


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WRIISC Model of Assessment & Care

Holistic/biopsychosocial approach Interdisciplinary team

WRIISC team and patient craft goals &next steps (Road Map)

Focus on optimizing health and function

Emphasize self-management

Goal and outcome oriented

Encourage timely reassessment by PACT Follow up at 1, 6, and 12 months


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Chronic Multisymptom Illness (CMI) atthe WRIISC

Review of the referrals

Team meeting and in the road map

Use of labels for chronic fatigue syndrome,fibromyalgia, and irritable bowel syndrome


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Symptoms reported by Veterans whocompleted NJ WRIISC intake packet

PHQ-15 symptom % Gulf War (n=46) % OEF/OIF/OND (n=66) Vietnam (n=28)

Stomach pain 24.4 19.7 32.1

Back pain 71.1 62.1 46.4

Pain in your arms, legs, or joints

(knees, hips, etc.)80.0 53.0 60.7

Menstrual cramps or other

problem with your periods

(Women only)

15.8 9.1 0

Headaches 48.9 39.4 17.9

Chest pain 11.1 9.2 10.7

Dizziness 17.8 31.8 7.1Fainting spells 0 4.6 0

Feeling your heart pound or race 15.6 27.3 3.6

Shortness of breath 26.7 17.2 32.1

Pain or problems during sexual

intercourse29.5 27.3 28.0

Constipation, loose bowels, or

diarrhea48.9 45.5 25.9

Nausea, gas, or indigestion 48.9 39.4 36.0

Feeling tired or having low energy 91.1 78.8 55.6

Trouble sleeping 88.9 83.3 63.0

PHQ-Depression 58.7 62.1 41.4

PCL-PTSD (>50) 39.1 43.9 24.1


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VHA encounters by GW Veteransbefore and after WRIISC Visit(Samore et al, IDEAS Center, SLC VAMC)


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ICD9 codes associated with GW Veterans VHA

encounters before and after a WRIISC visit(Samore et al, IDEAS Center, SLC VAMC)

0

1000

2000

3000

4000

5000

6000

7000

In the one year PRIOR toWRIISC visit

In the one year AFTERWRIISC Visit


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WRIISC CONTACT INFO www.warrelatedillness.va.gov

[email protected]

NJ WRIISC: 1-800-248-8005 or

[email protected]

CA WRIISC: 1-888-482-4376 or

[email protected]

DC WRIISC: 1-800-722-8340 or

[email protected]
http://www.warrelatedillness.va.gov/mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.warrelatedillness.va.gov/

Presentation – Dr. Drew Helmer - IOM Gulf War Illness "CMI" Panel.

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